Provider Demographics
NPI:1750577664
Name:TUCKER, JOI
Entity type:Individual
Prefix:
First Name:JOI
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HIGHLAND BLVD
Mailing Address - Street 2:APT B
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-6945
Mailing Address - Country:US
Mailing Address - Phone:302-326-1136
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:610-834-7525
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN274119164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse